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novalis comments on How to Deal with Depression - The Meta Layers - Less Wrong
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Comments (73)
This suggestion needs to be more specific. Otherwise, people will just say, "well, when I thought about my mood over the past week, it wasn't so great," or "I already know what my mood is like."
I found this app more-or-less at random. It has the advantage that the source code is on github so you can customize it to meet your specific needs.
Also, this article needs some citations. Like, any.
I'm not sure how including citations would improve this article. It's based on a personal experience. If the author had gone out and done a bunch of research, chosen a depression-relieving method based on those already studied, tried it, and then written about it, it would have made sense to include citations to the original research. But at this point, with the bottom line already written, looking up a couple of articles on depression just to have citations doesn't add anything to the presentation.
Citations to studies done personally would be enough. As-is, I have no reason to believe this article at all.
I think it would be better if the article said, "I've done a bunch of work with depressed people and here's a technique that seems to work. Now I want to test it. Email me if you would like to volunteer for a study that will take about five minutes per day for two weeks."
I would sign up for that study.
Huh. I'd love to see such a study done. I don't know if I have the time and energy for it right now, but I will consider it and keep this in mind.
I would be willing to run a study like this for you–it would have to be long distance/online, since I'm in Canada, but I could get some of the local LW-Ottawa people to help set up an online survey format.
I'd love to participate in such a study, I've noticed my moods go all over the place and would like to see how such a survey would work.
That would be awesome! Would you be up for a skype call to discuss this? My email is shannon dot friedman at positivevector.com, drop me a line and I'll send you my skype ID and availability.
Yes, good idea. We could treat this as a prediction, and try to actually test it.
I would also volunteer for such a study. (Un?)Fortunately, I doubt I'd make a valid sample, considering my recent lack of depressive states.
Okay. Recommendations I typically make are to take a baseline for two weeks of measuring daily, or for more ambitious people to measure several times throughout the day to get the baseline. What I did years ago was to set a stop watch to go off hourly, so that I was measuring my mood based on time and not based on when I thought to do it, since it is a bias to think "now is a good time to evaluate my mood."*
After getting a baseline, how often I would recommend checking after that would depend on the specific case and how much the person likes or dislikes doing regular mood checking. I think I'd recommend taking a baseline every few months in general, and then if something wonky happens or you have reason to think things are changing or if you want to see if they are changing, to check in at those times.
Having an app with code you can modify is great, thanks for the link.
Sorry about the lack of citations, I guess I should be more careful about that before posting to LW. Its based on personal experience working with clients, and going to workshops and things like that, so I didn't come up with it from reading, but I understand that citations are very important to this community.
*I was using a very short/simple set of metrics when measuring hourly that only took me a minute or two to fill out, I can see if I can dig it up if anyone is interested.
Citations can usually be dispensed with if you have better evidence presented in some other form. I think wording it as "this needs citations" is perhaps misleading - citations are only a good way to indicate to readers that there is clear evidence there, and lets them go look at said evidence.
While it's well understood that evidence of the form "This fellow rationalist believes X, thus I should update towards X because [insert the long bayesian reasoning]" is technically valid, it's also well understood (at least from what I've seen on LW) that humans are unable to adequately apply this by default, and so most of us deliberately reduce the effect of such updates in order to avoid such things spiraling out of control.
The charitable interpretation of "this needs citations" is: "This is interesting. Care to let us look at the numbers if you've found any?"
Thanks for explaining. I have not read anything else like this, hence my motivation to write it up. I imagine there is evidence out there, but I don't know how to find it - "meta depression" is my own descriptive language, I don't know how people in the psych community would identify this concept, so I don't know what I would search. I'd love to hear of anything anyone else finds.
I think REBT uses the term "Awfulizing" to describe a piece of this cluster. That might be a good place to start.
Thanks. That's a similar concept, but not what I'm most interested in - depression about being depressed is more specific than simple catastrophizing. Its the sort of thing that I think Less Wrongers would get that is more subtle than most material out there.
Correct me if I'm wrong, but giving medical advice that is not substantiated by scientific evidence is quackery.
Hm, looks to me like you committed the noncentral fallacy twice. "Scientific evidence"--evidence can still be evidence without being "scientific". "Quackery"--yeah, there are people who scam others with fake medical advice with little regard to the others' actual health. That doesn't mean that all medical advice from non-doctors should be disregarded. For example, I resolved a long-standing repetitive strain injury thanks to this guy. If I decided to disregard his advice because he wasn't a doctor, I'd probably still be controlling my computer using voice recognition (did this for almost a year and it seriously sucked).
For what it's worth, I attribute the vast improvement in my health over the last year to quackery (that is to say, advice given by non-doctors, based on assumptions that are far from being the consensus among those within traditional scientific institutions like medical associations and universities).
I'm sure you could find literaly millions of personal anecdotes of people who allegedly got better because of homeopathy, chromotherapy, magnotherapy, faith healing and whatever form of snake oil out there.
The effectiveness of medical procedures is essentially impossible to evaluate subjectively due to large aleatory effects, individual differences, sponteneous regression and the placebo effect. On the other hand, due to the large emotional effects of illness and death, medicine is the ideal fertile ground for fallacies such as wishful thinking, confirmation bias and for outright fraud.
Therefore, the value of medical advice unsupported by science is virtually zero. In fact, it could be argued that the existence of an unscientific medical practice in a society where scientific medicine is available is actually weak evidence that such practice is ineffective and possibly fraudulent.
You're discounting the possibility that "fringe" medical advice would have theoretical evidence behind it, as opposed to empirical evidence.
You're also not doing an expected utility calculation. What are the costs and benefits of following this particular bit of "fringe" medical advice? In my case, the cost was: I spent a few hours reading and massaging my arm, and discovered a knot in my bicep such that when I massaged it, my wrist pain was replicated. Benefits? I got my career back. Indeed, when I first heard about "trigger points" I thought the probability that they were legit was extremely low. But in retrospect, I'm glad I followed up all the low-probability leads that I did. In fact, I wish I'd done this sort of experimentation more and sooner--the cost-benefit analysis favored it overwhelmingly. (Unfortunately, severe depression seems to make it very hard for me to motivate myself to do things that I know have only a low probability of working.)
The fact that someone is passing it off as medical advice makes the probability of it being useful medical advice way, way higher than the probability that some random string of characters is useful medical advice. I agree that "fringe" medical advice is less likely to be useful than advice you get from doctors.
Are you talking about a theory rooted in solid biological and medical science or some alternative newagey theory like chakra points? Even within the realm of scientific theories, the ability to predict the actual effectiveness and safety of a therapy is generally limited: 92% of drugs that pass in vitro tests fail animal or human trials, and these are only the drugs that have already passed the computer-based design phase.
As far as I know, there are a number of conditions, notably inflammation, that are actually made worse by massage.
That's an irrelevant comparison, since nobody suggested to sample random strings for medical advice. In any case, an alleged medical advice also has a probability of being actually harmful way way higher than that of a random string.
You're not wrong.
I am not claiming to be giving professional medical advice, so it is a straw man argument - saying something true as a way to falsely invalidate.
Any form of depression that requires treatment, in particular major depression, is recognized as a severe medical condition that can be disabling and in some cases fatal, since depressed people have a significant suicide risk. Thus, any advice on how to treat depression is medical advice.
Moreover, you talk about experience with your clients, and if I understand correctly, you actually work as some sort of depression counselor. Your website even says "It’s like therapy, but better." Therefore, you are indeed giving professional medical advice that is not based on scientific evidence.
Sorry if this comes across rude, but it seems to me that what you are doing meets the definition of quackery.
I'm not an expert, but as far as I know, depression is very hard to treat and the only treatments that have shown some effectiveness supported by scientific evidence are antidepressants and cognitive behavioral therapy, and AFAIK, even antidepressants show a weak effect.
EDIT:
Just found this article that makes the point much better than me: http://www.thedailybeast.com/newsweek/2009/10/01/ignoring-the-evidence.html
The old school psych industry generally doesn't work. I went through a decade of professional therapy with professional therapists that did nothing for me, and only had things turn around once I started getting into other forms of help such as cutting edge Buddhist related philosophies such as life coaching. I actually help people when people who go through our "legal" fucked up system generally don't improve and often get worse. Most information out there is misleading and incomplete, including professional studies. The psych industry is a mess. The DSM is terrible, most therapists don't even agree on diagnoses. I was misdiagnosed personally for depression and given a drug that caused me to become manic, in a way that shifted my baseline psychological state permanently and caused me very bad problems for many years, as the result of taking the advice of a very prestigious professional psychiatrist who works at Stanford.
Basically, the whole field is fucked. I'm doing and sharing what I find most effective, which I actually do get results from. You can look at the testimonials on my site if you want, it seems you found them. I'm collecting more testimonials. I know what I am doing is not perfect, but I think its among the best, and that is the best I can hope for, and I would rather help people than not do anything because I'm waiting for perfection that is never going to come while people are suffering.
Sorry about the ranting, rough night.
If you work with people who didn't find the standard interventions helpful, and they find your assistance helpful, that doesn't mean your thing works better - it means it works better on a group filtered for finding standard interventions unhelpful.
Yeah, and I sunk into depression despite over a decade of various lifehacking philosophical gizmos, and you don't hear me saying that all of it is fucked and we should all just get on the happy pills. (You do hear me gushing overmuch about said happy pills.) If we're trading anecdotes all we're going to learn is that lots of stuff sometimes work but everything usually fails.
Obviously you're helping people, so go you, and obviously you're helping people more than conventional therapy because conventional therapy is just paying someone to kvetch at them regularly and that can only possibly help if you have no friends to do that with. (The advantage is that you can be suicidal and it's their problem because it's their job, whereas if a friend notices you're suicidal it's a suicide threat and you are a bad evil manipulative person and I should stop reading Captain Awkward.)
But I see no evidence that your coaching should be a first resort for mild depression, rather than a n-th resort after conventional means have failed or proven insufficient. And for major depression (where meds are much more useful than for mild depression anyway), what kind of presentation of major depression leaves you able to make big life changes?
As the article I linked points out, the actual penetration of science-based psychotherapy even among professionals is low, and certainly it was even lower one decade ago. Hence, your experience is far from surprising.
However, the proper course of action is to push for science-based psychotherapy, not to go for DIY or New Age ("cutting edge Buddhist related philosophies") systems that have possibly even less scientific support than mainstream methods.
Sure, you have experience that your method works. Freud had experience that his psychoanalysis worked. So did Jung. And Moniz and Freeman with their lobotomy. They even got testimonials and Moniz even won a Nobel Prize. But these practices were not supported by scientific evidence, and they ultimately proved ineffective and, in the case of lobotomy, actively harmful.
Beware of sponteneous regression (1/3 of mental health patients get better even without therapy), the placebo effect and the confirmation bias (researchers, even professional scientists, tend to rememeber favorable outcomes and forget unfavorable ones). There is a good reason why medical experimental protocols are so strict and complex.
No problem, best wishes.
I believe this is exactly the kind of services a couple of LessWrong users had in mind and are offering here, though I might be conflating terms somewhere.
Thankyou, installed!